7 ms·

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where h

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines they can buy, what medicine etc. Not saying the US system is better but all systems have drawbacks.

jacquesm 10y ago
Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before. Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.
- ThomPete 10y ago
  My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they get a serious illness. With regards to France healthcare system here is an article who seems to think it wont survive though. https://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke https://www.bloomberg.com/news/articles/2013-01-03/frances-h...
  - jacquesm 10y ago
    Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s
    - ThomPete 10y ago
      Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.
      - jacquesm 10y ago
        You wrote: > most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures. They typically can't pay for a new washing machine if their current one breaks down.
        ThomPete 10y ago
        Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle. There is a large number of people who can't afford to buy a washing machine but it's not most people.
        dragonwriter 10y ago
        > Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle. Wrong, income distribution isn't normal, it's bottom-heavy, and most people are well below the mean.
        pdkl95 10y ago
        https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2015 https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2015 Exactly. In 2015, most (50.08666%) wage earners earned less that $30,000/year. While it isn't a majority, the fact that 3-in-10 (29.72726%) earn less than $15,000/year is a travesty.
- giardini 10y ago
  I'm not so sure about "have their priorities straight there". Using the state to manage healthcare brings up strange priorities: "Should we cover kidney transplants or should our soldiers have real bullets in their guns this year?", "Should we build the new transit line or increase coverage to include penile transplants?", etc. I don't want people voting based on their appendix, their bad knee surgery, or a skin rash. Involving government in healthcare inevitably leads to possible futures wherein a country is brought to it's knees by colonoscopies. One's enemies can only laugh.
  - GavinMcG 10y ago
    You say it's inevitable. Surely, then, you have some evidence of this trend actively weakening countries? It's easy to sketch convincing strawmen. But if you could actually point to somewhere that is choosing between kidney transplants and bullets, I'd eat my hat.
    - ThomPete 10y ago
      No single payer system spend all the money they could on their healthcare system. I think this is what most people are missing. You could tax people 100% and you still wouldn't have enough to make your system as good as it can be. Plenty of single payer systems decides how long they are going to keep someone on treatment, what kind of products they allow them to be treated with etc. A single payer system is based on a budget which means that budgets size is based on how it's prioritized.
XorNot 10y ago
Ah yes, because the "market" for healthcare operates so well...
- ThomPete 10y ago
  It's really sad that it's impossible to discuss healthcare without people jumping into their pigeonholes. Healthcare isn't perfect anywhere in the world whether private or public. And even the US healthcare system isn't really market driven.
  - XorNot 10y ago
    That's my point. Any suggestion which starts with "this is unsustainable because the market isn't driving incentives right..." has completely missed what's going on in healthcare first and foremost: it's your life, and it's worth everything to save it. Opening with "let's have a market" isn't opening with a cogent position, since rational actor economic theory is completely unable to deal with this (sure, there might be others, but no one making this assertion wants to talk about them).
    - ThomPete 10y ago
      No I haven't missed anything at all I am just basing my reasoning on a different premise than yours. My premise is that you can never spend enough money on healthcare. There is always a need for better treatment, more treatment, new machines etc. Even if you taxed people 100% you could still spend more money because as you say it's worth everything to save it. But a political system is made to prioritize the resources that we have and so a singlepayer system cannot escape to have to come to terms with the boundaries of the budget it's given. There are many areas where a patient will not be treated or where the system decides it's not worth continuing to pay for some treatment. In a singlepayer system it gets decided what gets treated in a system which is more open to demand the market decides. None of these are without fault it's just important to keep their limitations in mind. This is why ex. the french system as much rave reviews it's gotten also sets limits to who it will treat. We can then have a discussion about whether it's better that everyone gets access to the same treatment or whether it's better that some people can get access to better treatment methods than others. But to ignore that a single payer system comes with it's own problems such as limits on how many people can be treated and for what and how long, is not taking the discussion serious.
ajnin 10y ago
You're right that the budget is tighter, however the healthcare budget is separate from the main state budget, and you can't have a situation where for example you'd allocate less to health to pay for schools or army or something like that. The money still comes from taxes though and there is enormous pressure currently due to the economic situation in Europe, especially from businesses, to lower those taxes. It can be sometimes hard to get people to defend this system when they have never had a big health concern before. However when you switch to a for-profit healthcare then the interests of the operators stop being aligned with those of the population. Even if there is more money, like in the US where the budget per person is about double that of France, it is not necessarily spent in a way that benefits the patients. State-run health avoids multiple administrative costs due to multiple actors, it avoids having to pay dividends to share holders, and as a single payer it has much more power over the pharmaceutical industry to lower costs. Overall it is a more efficient use of people's money.
- ThomPete 10y ago
  It's not separate from the reality that they have to decide what kind of ex. treatment they are going to support for how many etc.
  - nicky0 10y ago
    That seems more a theoretical or ideological objection. Yes there may be some outlying cases where people can't their treatment paid for and have to resort to going private, but the vast majority of citizens in countries with state healthcare enjoy free and effective healthcare for their entire lives.
maxerickson 10y ago
Much of the US has certificates of need which impose limits on who can operate certain machines or have a hospital. And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.
- ThomPete 10y ago
  This is not the market fault it's the political system and reimbursement rules which creates perverse incentives. Some hospitals have begun to get reimbursed based on how well the patients gets treated called value based treatment.
  - maxerickson 10y ago
    I was implying that the US doesn't really have a market.
    - ThomPete 10y ago
      Compared to Europe it does though. I.e. the us healthcare system does't get most of it's payment through taxation. Thats an important distinctions.
      - maxerickson 10y ago
        I guess. Medicaid and Medicare are more than a third of spending and don't necessarily cover the total costs of the care provided under the programs (any unmet costs are a hidden tax). The VA is not nearly as expansive as those programs but is another couple whole percentage points of US health spending. And you've also got Tri Care and some BIA stuff, and state expenditures that are outside of Medicaid.
        ThomPete 10y ago
        Not sure we are discussion the same thing. My point is that a singlepayer system payed by the taxpayers and budgeted by the politicians isn't making money it can only spend less money. A system like the american overall can make money, it's it's goal to profit. That's the difference between whether it's a market driven market or not IMO.
DanBC 10y ago
> and thus has budgets that are politically mandated not determined by market demand at least not directly. Why is market demand a good thing? In the US the government spends more per capita than France, but gets worse health outcomes.
- ThomPete 10y ago
  It's neither a good or a bad thing. The US system isn't the only way a marketdriven system can be and a lot of it's problems are lobby and politics related. Market demand is a good thing in the sense that it creates better allocation of resources. The US doesn't have a healthcare market driven by market demand. But the fact is that the US system has more advanced treatment methods. The problem is that it's not evenly distributed.
cortic 10y ago
I do question the morality of the US system, and the sustainability of inflated prices it creates. Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly. This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc. Not saying the EU system is better, but then that depends whether you are a shareholder or a patient.
- ThomPete 10y ago
  I am unconvinced any of the systems are sustainable. The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.
  - cortic 10y ago
    EU systems get much better outcomes for a fraction of the cost, and you think that's 'unsustainable'? 'lobbying' can be dealt with a either side of the pond, the only thing you are arguing for is making profit from the poor and sick.
    - ThomPete 10y ago
      Better outcomes doesn't shield you from in-sustainability if your cost still is bigger than the money you can afford to put into it. The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system. In a system more driven by market you can actually make money. It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.
      - cortic 10y ago
nicky0 10y ago
The way I see it is as long as the state provides effective and accessible healthcare, things like hospital choice over equipment or drug supplier is a "nice to have". Prioritizing these things seems like freedom for freedom's sake.

jacquesm 10y ago

Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before. Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.

ThomPete 10y ago
My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they get a serious illness. With regards to France healthcare system here is an article who seems to think it wont survive though. https://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke https://www.bloomberg.com/news/articles/2013-01-03/frances-h...
- jacquesm 10y ago
  Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s
  - ThomPete 10y ago
    Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.
    - jacquesm 10y ago
      You wrote: > most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures. They typically can't pay for a new washing machine if their current one breaks down.
      - ThomPete 10y ago
        Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle. There is a large number of people who can't afford to buy a washing machine but it's not most people.
        dragonwriter 10y ago
        > Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle. Wrong, income distribution isn't normal, it's bottom-heavy, and most people are well below the mean.
        pdkl95 10y ago
        https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2015 https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2015 Exactly. In 2015, most (50.08666%) wage earners earned less that $30,000/year. While it isn't a majority, the fact that 3-in-10 (29.72726%) earn less than $15,000/year is a travesty.
giardini 10y ago
I'm not so sure about "have their priorities straight there". Using the state to manage healthcare brings up strange priorities: "Should we cover kidney transplants or should our soldiers have real bullets in their guns this year?", "Should we build the new transit line or increase coverage to include penile transplants?", etc. I don't want people voting based on their appendix, their bad knee surgery, or a skin rash. Involving government in healthcare inevitably leads to possible futures wherein a country is brought to it's knees by colonoscopies. One's enemies can only laugh.
- GavinMcG 10y ago
  You say it's inevitable. Surely, then, you have some evidence of this trend actively weakening countries? It's easy to sketch convincing strawmen. But if you could actually point to somewhere that is choosing between kidney transplants and bullets, I'd eat my hat.
  - ThomPete 10y ago
    No single payer system spend all the money they could on their healthcare system. I think this is what most people are missing. You could tax people 100% and you still wouldn't have enough to make your system as good as it can be. Plenty of single payer systems decides how long they are going to keep someone on treatment, what kind of products they allow them to be treated with etc. A single payer system is based on a budget which means that budgets size is based on how it's prioritized.

XorNot 10y ago

Ah yes, because the "market" for healthcare operates so well...

ThomPete 10y ago
It's really sad that it's impossible to discuss healthcare without people jumping into their pigeonholes. Healthcare isn't perfect anywhere in the world whether private or public. And even the US healthcare system isn't really market driven.
- XorNot 10y ago
  That's my point. Any suggestion which starts with "this is unsustainable because the market isn't driving incentives right..." has completely missed what's going on in healthcare first and foremost: it's your life, and it's worth everything to save it. Opening with "let's have a market" isn't opening with a cogent position, since rational actor economic theory is completely unable to deal with this (sure, there might be others, but no one making this assertion wants to talk about them).
  - ThomPete 10y ago
    No I haven't missed anything at all I am just basing my reasoning on a different premise than yours. My premise is that you can never spend enough money on healthcare. There is always a need for better treatment, more treatment, new machines etc. Even if you taxed people 100% you could still spend more money because as you say it's worth everything to save it. But a political system is made to prioritize the resources that we have and so a singlepayer system cannot escape to have to come to terms with the boundaries of the budget it's given. There are many areas where a patient will not be treated or where the system decides it's not worth continuing to pay for some treatment. In a singlepayer system it gets decided what gets treated in a system which is more open to demand the market decides. None of these are without fault it's just important to keep their limitations in mind. This is why ex. the french system as much rave reviews it's gotten also sets limits to who it will treat. We can then have a discussion about whether it's better that everyone gets access to the same treatment or whether it's better that some people can get access to better treatment methods than others. But to ignore that a single payer system comes with it's own problems such as limits on how many people can be treated and for what and how long, is not taking the discussion serious.

ajnin 10y ago

You're right that the budget is tighter, however the healthcare budget is separate from the main state budget, and you can't have a situation where for example you'd allocate less to health to pay for schools or army or something like that. The money still comes from taxes though and there is enormous pressure currently due to the economic situation in Europe, especially from businesses, to lower those taxes. It can be sometimes hard to get people to defend this system when they have never had a big health concern before. However when you switch to a for-profit healthcare then the interests of the operators stop being aligned with those of the population. Even if there is more money, like in the US where the budget per person is about double that of France, it is not necessarily spent in a way that benefits the patients. State-run health avoids multiple administrative costs due to multiple actors, it avoids having to pay dividends to share holders, and as a single payer it has much more power over the pharmaceutical industry to lower costs. Overall it is a more efficient use of people's money.

ThomPete 10y ago
It's not separate from the reality that they have to decide what kind of ex. treatment they are going to support for how many etc.
- nicky0 10y ago
  That seems more a theoretical or ideological objection. Yes there may be some outlying cases where people can't their treatment paid for and have to resort to going private, but the vast majority of citizens in countries with state healthcare enjoy free and effective healthcare for their entire lives.

maxerickson 10y ago

Much of the US has certificates of need which impose limits on who can operate certain machines or have a hospital. And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.

ThomPete 10y ago
This is not the market fault it's the political system and reimbursement rules which creates perverse incentives. Some hospitals have begun to get reimbursed based on how well the patients gets treated called value based treatment.
- maxerickson 10y ago
  I was implying that the US doesn't really have a market.
  - ThomPete 10y ago
    Compared to Europe it does though. I.e. the us healthcare system does't get most of it's payment through taxation. Thats an important distinctions.
    - maxerickson 10y ago
      I guess. Medicaid and Medicare are more than a third of spending and don't necessarily cover the total costs of the care provided under the programs (any unmet costs are a hidden tax). The VA is not nearly as expansive as those programs but is another couple whole percentage points of US health spending. And you've also got Tri Care and some BIA stuff, and state expenditures that are outside of Medicaid.
      - ThomPete 10y ago
        Not sure we are discussion the same thing. My point is that a singlepayer system payed by the taxpayers and budgeted by the politicians isn't making money it can only spend less money. A system like the american overall can make money, it's it's goal to profit. That's the difference between whether it's a market driven market or not IMO.

DanBC 10y ago

> and thus has budgets that are politically mandated not determined by market demand at least not directly. Why is market demand a good thing? In the US the government spends more per capita than France, but gets worse health outcomes.

ThomPete 10y ago
It's neither a good or a bad thing. The US system isn't the only way a marketdriven system can be and a lot of it's problems are lobby and politics related. Market demand is a good thing in the sense that it creates better allocation of resources. The US doesn't have a healthcare market driven by market demand. But the fact is that the US system has more advanced treatment methods. The problem is that it's not evenly distributed.

cortic 10y ago

I do question the morality of the US system, and the sustainability of inflated prices it creates. Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly. This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc. Not saying the EU system is better, but then that depends whether you are a shareholder or a patient.

ThomPete 10y ago
I am unconvinced any of the systems are sustainable. The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.
- cortic 10y ago
  EU systems get much better outcomes for a fraction of the cost, and you think that's 'unsustainable'? 'lobbying' can be dealt with a either side of the pond, the only thing you are arguing for is making profit from the poor and sick.
  - ThomPete 10y ago
    Better outcomes doesn't shield you from in-sustainability if your cost still is bigger than the money you can afford to put into it. The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system. In a system more driven by market you can actually make money. It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.
    - cortic 10y ago

nicky0 10y ago

The way I see it is as long as the state provides effective and accessible healthcare, things like hospital choice over equipment or drug supplier is a "nice to have". Prioritizing these things seems like freedom for freedom's sake.